Abnormal Living Entozoa in the 
Human Ear, 
By WALTER B. JOHNSON, M.D., 
Surgeon to the Patterson Eye and Ear Infirmary, 
PATTERSON, N. J. 
Reprint from The Ophthalmic Record, Nashville, Tenn. 
NASHVILLE, TENN.: 
A. R. Gray & Son, Book and Job Printers 
1892. ABNORMAL LIVING ENTOZOA IN THE HUMAN EAR. 
Written for tlie Ophthalmic Record by 
WALTER B. JOHNSON, M. D., 
Surgeon to the Paterson Eye and Ear Infirmary, 
Patebson, N. J., 
A patient, having an old suppurative Otitis Media in the left 
ear which had not been under observation for some time, applied 
for treatment at the Infirmary, in consequence of an increased 
discharge and some peculiar sensations about the middle ear. 
He described his symptoms as a feeling of throbbing, and on 
closer questioning, he complained that the sensation was that of 
constant movement and running of matter from the ear, entirelv 
out of proportion to the actual amount of the discharge; there 
were noises of various kinds and of large volume almost con- 
stantly present. 
These symptoms had been aggravated for about one week, 
being more noticeable at some times than at others, and being 
decidedly more constant during the last three days. 
He had been able to sleep some, but was frequently disturbed 
by the throbbing or feeling of discharge, tinnitus, and pain 
when awakening during the night. He only had a moderate 
amount of pain, although sharp stitches would come, and the 4 
Walter B. Johnson, M.D. 
ear was constantly more uncomfortable than it had been pre- 
viously to the present attack. 
The patient was a strong, well-nourished man, in good health ; 
he had no new pharyngeal inflammation and nothing to indicate 
the presence of an exciting cause for the recurrent Otitis, as up 
to the time of the onset of the trouble, he had, as the only 
symptom, a very slight, but offensive discharge. 
On examination, a profuse, muco-purulent discharge of 
considerable thickness, yellow in color, and excessively odorous, 
was found in the external-auditory canal. 
The discharge was dried out very carefully, and when all was 
entirely clear, the thickened, moderately inflamed drum mem- 
brane was examined, and a large perforation, involving the 
lower inferior posterior quadrant of the tympanum was disclosed. 
In re-examining the ear shortly after, there appeared in, and 
about the opening, a white substance, which was thought to be 
some of the white exfoliated skin so frequently removed from 
the ears of such patients. 
An effort at its removal, resulted in its complete disappear- 
ance (although nothing came away on the cotton used in drying 
the ear), and a decided increase in the discomfort of the patient, 
who complained of a severe lancinating pain. 
The patient was asked to sit quitely for a time with his head 
resting on the left hand; he complained of very excessive 
throbbing, buzzing and movement in the ear for the next fifteen 
minutes. When he was again examined, the white material was 
again present in the aperture and being excited by the examina- 
tion was seen to move through the opening and pass entirely 
out of sight. It was then concluded that some living organism 
was present in the ear and after an ineffectual effort to remove 
by syringing, the patient was directed to assume the same 
position, resting the ear on the hand, as likely to encourage 
warmth, and assist in again luring it from the cavity of the 
middle ear. 
The movement and sensations as above described continued, 
and at the end of half an hour the examination was repeated, 
the speculum was rapidly introduced and Pol owed by a pair of 
fine rat-tooth ear forceps. The body was in sight and it was Entozoa in the Human Ear. 
5 
siezed and instantly removed. It held to the mucous membrane 
with sufficient force to cause some hemorrhage. 
On examination this body was considered to be an ordinary 
maggot, it was of large size fully 2 inch in length and very fat, 
it was quite lively. 
There was a small red spot in the maggot, which raised the 
question of the possibility of its having recently eaten some 
human blood corpuscles, while within the cavity of the middle 
ear. 
My friend Dr. Neil J. Hepburn suggested the advisability of 
sending the specimen to the Rev. Samuel Lockwood, Ph. D., 
Secetary of the New Jersey State Microscopical Society, an 
accomplished Entomologist of Freehold, N. J., who writes:- 
"The larva sent was not seen alive by me, but it is in spirits, 
and its form is well preserved. It is a true dipteran larva, 
being the grub, or maggot of the flesh fly, or meat-fly, Sarcorphaga 
carnaria (Linn), This must not be mistaken for the blue-bottle, 
or blow fly, musca vomitoria, which lays its eggs on flesh, or 
meat. The Sarcophaga carnaria is viviparous. The eggs 
hatch and live within the oviduct of the female, and these tiny, 
very white grubs are each about .06 of an inch in length, and 
are deposited upon meat, which they devour ravenously, grow- 
ing to the length of | or f of an inch. They then enter the 
ground, and assume the pupa form. But as the form of the 
pupa of the fly differs from the pupa of many other insects, the 
condition at this stage of its life is known as the puparium, 
after this it has but one metamorphosis, when it evolves into the 
complete and perfect fly. 
"I have used the word larva in respect to the specimen. This 
is not quite systematic, as it has reached a pupal stage ; it is in 
fact a puparium, but not quite complete. I should think it is 
within a day or two of this state. The form of the puparium 
is figured in my article: ' A Viviparous Fly,' in American 
Naturalist, Vol. vii, 1873, p 194. My belief is that the speci- 
men when taken from its nidus was about ten days old. I think 
its peculiar lodging place, the human car, has lengthened by two 
or three days the usual time require! to reach the stage attained 
by the specimen. By good fortune you struck the opportune 6 
Walter B. Johnson, M.D. 
time for extracting it, as at the time of making the pupal change, 
the larva is very restless. A day or two later the ability of 
changing place or position would have been lost and whether it 
died or evolved into a perfect fly, the condition of your patient 
would have been pitiable. 
"How came this larval insect in the middle ear? We can 
do little more than conjecture. You say it was seized and ex- 
tracted from the external canal of the ear, it having returned 
there by a hole in the tympanic membrane, through which it had 
before escaped you. It seems to me then that its nidus was the 
tympanic cavity. If that hole, or rupture was over ten days old, 
the larva could have entered it from the external canal, the little 
grub having been deposited there by the parent fly. The car- 
nivorous flies are easily deceived by scent. Sometimes they will 
deposit their grubs or eggs in an ill-scented flower, mistaking it 
for tainted meat. In fact upon any malodorous object if it be 
vegetal or animable. Some ears have an offensive smell. Might 
not even the diseased tympanum have been attractive ? 
'* Though it may seem strange, I think it more likely that the 
tiny larva, only the .06 of an inch in length should have found 
its way from the mouth up the Eustachian tube. I send you two 
small pamphlets of mine on Abnormal Entozoa in man, reprints 
from the American Joarnal of Microscopy, Jan. 1881 and May 
1881, by which you can see that these parasites have taken 
possession of the human stomach through the medium of cold 
boiled cabbage, and meat. Supposing your patient to have eaten 
cold tainted meat, and when a morsel was in his mouth, to have 
for some cause coughed, or in some way dislodged a tiny larva 
of our Sarcophaga so that it was thrown upon, or near to, the 
beginning of the Eustachian tube. To me there is nothing 
marvellous in the insects travelling up the epithelial walls, some- 
what slowly, and feeding on the mucus, until when it had taken 
possession of the interior of the ear, it attacked and fed 
upon the pus of the tympanic cavity. The spot of blood 
mentioned in your letter I think had not much to do with the 
matter at the time of extracting it, as it seems to me, it had gone 
so far into the pupa state as to make feeding no longer possible. Entozoa in the Hitman Ear. 
7 
The odor of decomposed pus might attract it to ascend the 
Eustacian tube. 
"To make the discussion complete you will have noticed that 
some questions might be put to your patient with advantage. 
" 1. Had he been eating suspicious cold meat or cooked vegeta- 
bles at about seven to ten days previous to the time of the ex- 
traction of the larva ? 
" 2. Had he experienced any sensation in the Eustachian tube 
when it began? when it stopped? 
" 3. When did the perforation of the tympanum occur ? 
"4. Was there a malodorous condition of the external ear?" 
The questions suggested by Prof. Lockwood were asked, and 
the answers were such as to point undoubtedly to the parent fly 
of the species Sarcophaga carnaria, having deposited the grub, 
already born, in the malodorous secretion of the ear, on which it 
fed until sufficiently developed to become active, when it began 
its course of constant torment to the patient, by crawling about in 
the pus, or by being constantly carried out of the cavity of the 
middle ear by the increasing discharge, and then returning 
again, giving rise to all the symptoms complained of by the 
patient. 
The extreme activity of the puparium, and its frequent pas- 
sage from the external auditory canal to the middle ear are very 
interesting, also the history of the birth, growth and develop- 
ment of the larva, and the suggestion of the probability of the 
larva having made its way to the middle ear through the Eusta- 
chian tube. 
The possibility of the puparium passing into the next stage 
of development, and becoming a winged fly, while it remained 
in the ear, is very slight, as it would probably have been dis- 
charged with the pus, when it entered the stage of rest, or if 
further development were possible it would have suffocated in 
the pus and subsequently come away with the discharge either 
in mass or piece-meal. 
197 Market St.